What is steroid-associated osteonecrosis of the knee, and who is most affected?

Steroid-associated osteonecrosis of the knee is a condition where high-dose corticosteroids disrupt blood flow to the knee bones, causing bone death. This predominantly affects young individuals, particularly those treated with corticosteroids for autoimmune diseases or malignancies. The resulting bone death can lead to significant pain, reduced mobility, and potential joint collapse, severely impacting the quality of life for affected individuals.

How does fresh osteochondral allograft (OCA) transplantation compare to total knee arthroplasty (TKA) for steroid-associated osteonecrosis?

Total knee arthroplasty (TKA) is the traditional treatment for advanced osteonecrosis, offering pain relief and improved function. However, TKA has limitations, especially for young, active patients who may place higher demands on the replaced joint, potentially leading to future revisions. Fresh osteochondral allograft (OCA) transplantation offers a biological repair strategy by replacing damaged bone and cartilage with healthy tissue from a deceased donor. OCA aims to postpone or prevent the need for TKA, providing a potentially durable, long-term solution for younger patients.

What were the key findings of the study regarding fresh osteochondral allografts for steroid-associated osteonecrosis?

The study revealed significant improvements in pain, function, and overall knee health following fresh osteochondral allograft (OCA) transplantation. Mean IKDC pain scores decreased substantially, and function scores improved. The overall knee health, as measured by the IKDC total score, also showed significant improvement. Furthermore, the study indicated that over 80% of the knees treated with OCA successfully avoided the need for knee arthroplasty at the 10-year mark, demonstrating the long-term durability of the procedure.

What are the limitations of fresh osteochondral allograft (OCA) transplantation for steroid-associated osteonecrosis?

While the results of the study are encouraging, fresh osteochondral allograft (OCA) transplantation isn't a perfect solution. Some patients may still require additional surgeries or eventually need total knee arthroplasty (TKA). Moreover, the success of the procedure may depend on careful patient selection. More research is needed to refine patient selection criteria and surgical techniques to further improve outcomes and ensure lasting benefits.

What are the implications of the Merle d'Aubigné-Postel score improvement after fresh osteochondral allograft (OCA) transplantation?

The improvement in the Merle d'Aubigné-Postel score, a measure of pain, mobility, and walking ability, highlights the positive impact of fresh osteochondral allograft (OCA) transplantation. This score's increase from 11.4 to 15.1 indicates a significant enhancement in the patient's functional status. This improvement signifies not only pain reduction but also a restoration of mobility and better walking ability, contributing to an improved quality of life for individuals with steroid-associated osteonecrosis.

Hope for knees through osteochondral allograft

Osteonecrosis Breakthrough: Can Allografts Save Your Knees?

Theo Raines in Health & Wellness December 2025 • 5 min read.

"Long-term study reveals promising outcomes for steroid-associated osteonecrosis using fresh osteochondral allografts, offering hope and mobility to younger patients."

Steroid-associated osteonecrosis of the knee is a rare and devastating condition that primarily affects young individuals. This condition occurs when high-dose corticosteroids, used to treat autoimmune diseases or malignancies, disrupt blood flow to the bones in the knee, leading to bone death and eventual joint collapse. The pain and limited mobility can severely impact quality of life, making everyday activities challenging.

Traditionally, total knee arthroplasty (TKA) has been the standard treatment for advanced osteonecrosis. While effective in relieving pain and restoring function, TKA has limitations, especially for younger, more active patients. These individuals often place higher demands on their replaced joints, increasing the risk of future revisions due to wear and loosening. This reality has spurred the search for biological repair strategies that can postpone or even prevent the need for TKA.

One such strategy is osteochondral allograft (OCA) transplantation, which involves replacing the damaged bone and cartilage with healthy tissue from a deceased donor. While previous studies have shown promise for OCA in treating osteonecrosis caused by trauma or other conditions, long-term data on its effectiveness in steroid-associated osteonecrosis has been lacking. A new study offers hope, demonstrating the potential of fresh osteochondral allografts to provide lasting relief and improve function in this challenging patient population.

Fresh Osteochondral Allografts: A Lasting Solution for Knee Osteonecrosis?

Hope for knees through osteochondral allograft

A recent retrospective study published in CARTILAGE journal, led by Samuel Early, Luís E. P. Tírico and William D. Bugbee, investigated the long-term outcomes of fresh OCA transplantation for steroid-associated osteonecrosis of the femoral condyles. The study followed 25 patients (33 knees) who underwent OCA transplantation between 1984 and 2013, with an average follow-up of 11 years. This research provides critical insights into the durability and effectiveness of OCA in this specific patient group.

The study found that fresh OCA transplantation significantly improved pain and function in patients with steroid-associated osteonecrosis. The key findings highlight the effectiveness of this procedure:

Pain Reduction: Mean IKDC pain scores improved significantly, decreasing from 7.2 preoperatively to just 2.8 at the latest follow-up.
Improved Function: Mean IKDC function scores also showed substantial improvement, increasing from 3.3 to 6.5.
Overall Knee Health: The mean IKDC total score increased from 31.9 to 61.1, indicating a significant overall improvement in knee health.
Knee Society Function: Mean Knee Society function score increased from 61.7 to 87.5.
Merle d'Aubigné-Postel Score: The mean modified Merle d'Aubigné-Postel score improved from 11.4 to 15.1.

More than 80% of the knees treated with OCA successfully avoided the need for knee arthroplasty at the 10-year mark, and 73% of the knees avoided any other surgical intervention. These results suggest that fresh OCA transplantation can offer a durable, long-term solution for younger patients with steroid-associated osteonecrosis, potentially delaying or even preventing the need for TKA. Also, the outcomes suggest that carefully selected patients are more likely to have lasting benefit from this treatment option.

What's Next?

While the results of this study are encouraging, it's important to remember that OCA transplantation is not a perfect solution. Some patients may still require additional surgeries or eventually need TKA. However, for young, active individuals with steroid-associated osteonecrosis, fresh OCA transplantation offers a valuable option to maintain function, reduce pain, and potentially postpone the need for more invasive procedures. More research is needed to refine patient selection criteria and optimize surgical techniques to further improve outcomes. If you're experiencing knee pain and suspect you may have osteonecrosis, talk to your doctor to explore the best treatment options for your specific situation.